So Lets Simplify This Complex Of Freezing Of Gait Brain Scenario
- So, it appears Freezing of Gait involves disordered communication and processing of information between networks involving the:
- front of the brain that plan and initiate movement
- basal ganglia where the dopaminergic neurons that fine tune and exert control over movement
- parts of the brainstem which again refine movement and support wakefulness
So, its a complex scenario involving a breakdown in brain circuitry and processing. Therefore, the response to this situation requires a multi-pronged and personalised response.
What Can I Do As A Caregiver
Freezing is completely involuntary. Rushing the person, getting impatient or saying things like lets go or hurry up can prolong freezing periods.
Instead, wait a few seconds for the person to find and implement a strategy to overcome the episode. If they do not succeed on their own, help them. For example, you can put your foot in front of them so they can step over it, or you can sound out a beat or rhythm .
Do not try to pull the person forward as they can fall, but you can help them with weight transfer movements from one leg to the other.
What Are Parkinsons Freezing Gait Symptoms
Some people describe their Parkinsons Disease freezing symptoms as
- Like being stuck in mud
- My feet are stuck to the floor
- Someone has hit my pause button but I really want to go
- Im yelling at my legs to move and they wont
- Its like my brain shuts down and yep stuck
- Im in a fog
- Fatigue, thats my thing I feel so tired
- Im glued in!
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Tips To Help You Get Over A Freezing Episode
Its estimated that around a third of people living with Parkinsons disease experience freezing from time to time. Freezing often happens when patients are walking and suddenly change direction or while raising the foot to go up a step, but it can also affect arm movements and even speech. Freezing can lead to falls and contribute to loss of mobility.
While it may not be possible to avoid freezing incidents altogether, there are ways to quickly overcome the episodes according to the American Parkinsons Disease Association.
Change directionIf you freeze while moving forward, try moving to the side or backward for a couple of steps.
Move differentlyPoint to the ceiling or touch your nose just doing something different from the original movement should be enough to break the freezing.
Use a laser pointerA laser pointer can be useful to help you quickly overcome freezing, pointing the laser in front of your foot and then standing on the laser spot will usually do the trick.
MORE: What is freezing in Parkinsons disease?
Step over somethingYou can either step over a crack on the sidewalk or visualize an item to physically step over.
Use a mini metronomeA mini, portable metronome is useful for providing a beat which can help you avoid freezing or get you started again.
Singing or hummingSinging or humming a song and then restarting in time with the beat can help break the freezing spell.
Counting out a rhythm or saying one, two, three, go can help overcome freezing.
Why Does Freezing Happen In Parkinsons Disease
Its clear, anything to do with the brain is far from simple.
When it comes to the brain networks which controls your gait, yep you guessed it, its complex.
Your walking pattern relies on multiple connections and pathways between various parts of the brain.
Freezing of gait can be viewed like a good detective novel.
Movement is a dynamic activity. It adapts and responds to the world around us. As a result, there are a number of brain regions or characters implicated as being involved with Freezing of Gait in Parkinsons Disease.
These brain areas are widely distributed and act in a synchronised and consistent manner.
You could say movement involves dynamic brain network coordination, and its this circuitry, this network behaviour, which appears to be affected and in the end gives rise to Parkinsons freezing of gait .
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Nexstride Helps Get You Moving
A small device with massive power, NexStride, is the first multi-cue daily assist mobility device that attaches to any standard cane, walker, or walking pole. NexStride’s power lies its ability to adjust to personal preferences. It enables individuals to find and set a comfortable pace and make quick and easy adjustments as they see fit.
What Freezing Is Like For My Dad
Like many Parkinsons patients, my dad notices that he usually only freezes when hes not on his medication. It usually happens while hes moving through doors: When you pivot youre worried about losing your balance. Thats why we shuffle our feet and take baby steps initially. Once Im moving Im fine, he says.
Since hes worried about maintaining balance while navigating, its possible that theres a connection between fear and freezing. Continuous motion seems to bypass the risk of freezing, while shifting motion types can present challenges.
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Verbal Control Of Weight
In early stages of learning/re-learning motor skills, performers will typically rely on explicit verbal rules that specify the most fundamental characteristics of the task . However, such processes can become detrimental in later stages of learning through the disruption of movement automaticity . This over-reliance on verbal movement rules, also known as reinvestment , is associated with increased cognitive task demands and a decline in motor performance during gait in healthy young and older adults , and in a range of sporting, balance, and vocational tasks .
Is Freezing Related To The Intake Of Dopaminergic Medication
Some people with Parkinsons have on and off periods, when they switch from being able to move when their medication level is higher to being unable to move without difficulty when their medication level is low . Many people notice that freezing is worse when their medication level is low, when they are off. But freezing is not the same as being on or off.
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Walking Aids To Help With Freezing Of Gait
Often freezing of gait cannot be overcome with medication adjustment and physical therapy, and a walking aid needs to be introduced for safety and walking support.
There are many types of walkers that are available for people with walking difficulties. Here is a simple guide:
- Basic walker this is usually just a metal frame without wheels
- Wheeled walker a metal frame with wheels. The wheels may be on two or four legs and the wheels may swivel or be fixed
- Rollator a walker with swivel wheels on all four legs and hand brakes. The brakes typically need to be engaged for the walker to stop. Often the rollator has a seat and a basket for convenience.
A common concern with all these walkers is that there either is no braking system or the braking system must be engaged in order for the walker to be stopped. Therefore, if a freeze occurs with the feet stuck to the floor, and the person is not fast enough to engage the brake, the walker will continue to move, potentially precipitating a fall.
Your physical therapist can help you determine the walking aid that is best-suited for your specific situation.
Rhythmical Or Auditory Cues
- A steady beat from a metronome or suitable music can help. The rhythm should be a comfortable pace, the beat prompting you to lift your feet and step.
- Develop a trigger word such as go, step or march to re-start your walking.
- Try closing your eyes to take the first step, making sure it is safe to do so, then open your eyes to continue walking.
- Hum a tune or download music with a good beat onto an MP3 player to keep your walking pattern going. Remember though that you should not use your MP3 in busy places where you should listen for traffic.
- The cue timing can be varied according to where you are, for example you will probably walk faster when outside, and slower in your home. See our video – Coping Strategies: overcoming freezing by counting 1 and our video – Overcoming freezing by counting 2.
- A physiotherapist or occupational therapist may be able to advise on mini metronomes or similar devices that can be clipped onto clothing so can be taken with you anywhere.
Attentional strategies use your imagination
The weight shift method
Start hesitation
Touch
- Touching a particular part of the body can also sometimes be helpful as a cue to unblock freezing see our video: Coping Strategies: using touch as a cue.
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What Is Freezing Of Gait
Whatever your experience of FoG is, there are some common features of this gait pattern.
- Firstly, FoG is defined as a brief episodic absence or marked reduction of forward progression of the feet despite the intention to walk .
- Freezing of gait is a major disabling motor symptom that affects the daily quality of life of Parkinsons disease patients.
- FoG appears commonly at advanced or later stages of the disease experience: Prevalence of FoG increases with longer disease duration. It has been reported that 81% of PD patients experienced FOG after a disease duration of 20 years.
- BUT a mild form can be seen in the early stages.
- Moreover, clinical features cited are: motor dysfunction, sleepiness, fatigue, and cognitive dysfunction
- And this differs to what the patient reports such as postural instability and walking pattern difficulty.
Why Do People With Parkinsons Freeze
Some people are more prone to freezing than others. It tends to occur with increased frequency as Parkinsons progresses and appears to be linked to long-term use of levodopa. It can be experienced by people who do not take levodopa, so it is not simply a side effect of medication.
Whatever the cause, not everyone with Parkinsons will experience freezing and it is impossible to accurately predict those who will. Freezing seems to be more prevalent in those whose initial symptoms included gait problems, and less prevalent in people who initially present with tremor.
The exact cause of freezing is unclear, but it is thought to occur when there is an interruption to a familiar or automatic sequence of movements. During walking, freezing is mainly observed when:
- you are walking towards doorways, chairs or around obstacles
- you are turning or changing direction, especially in a small space
- you are distracted by another task when you are walking
- you are in places that are crowded, cluttered or have highly patterned flooring
- the flow of your walking is interrupted by an object, by someone talking, or if you begin to concentrate on something else. All of these will stop you from being able to keep a rhythm going
- your medication is ‘wearing off’ and no longer controlling symptoms as well
- youre in a group situation or in conversation.
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Common Triggers Or Causes Of Freezing Of Gait
- Narrow spaces or tapering corridors
- A disruption to your walking pattern
- Change direction: A change of direction can induce a freezing experience
- Crowded places
- Crowded rooms
- Responding to unexpected events like being rushed or startled: Trying to get to the toilet on time
- Changes in walking surfaces
- Transitions between environments breaks or lines in the walking pathway be they inside or out. This may be experienced in shopping centres with the electric sliding doors or escalators. On and off public transport
You can appreciate that in the spacious clinic, with uniform floor surfaces it is often hard to detect freezing of gait.
It happens in everyday life away from the clinic.
Thats why we offer in tele-therapy, in home and community consultations.
It allows us to assess the impact of PD in your life and to design personalised plans with the goal to help you live a more independent life.
Ways To Reduce Parkinsons Freezing Of Gait
Do you sometimes feel like your feet are stuck to the floor or your hips are glued to your chair, despite your best efforts to move them?
This symptom, called freezing, has been seen in 30-67% of people diagnosed with Parkinsons, with a higher rate of incidence in later stages.
While everyone has unique freezing patterns, some common triggers include: turning in tight spaces, walking through doorways, walking in narrow hallways or crowded places or changing walking surfaces .
As soon as you notice freezing symptoms creeping up on you, its important to address them so you can prevent them from worsening over time.
The first line of treatment is often dopaminergic medications that aim to keep you in an ON state for longer. However, evidence suggests there is a cognitive component of freezing that medication and deep brain stimulation do not address effectively.
This is why the best long-term treatment option for Parkinsons freezing is non-pharmaceutical, non-invasive and focuses on retraining your brain for success.
Here are six actions you can take to help minimize your freezing of gait.
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Techniques To Overcome Freezing
Physical therapy and occupational therapy can be helpful to reduce or overcome freezing episodes. Physical therapy focuses on the physical rehabilitation of people recovering from injuries or disease with the goal of restoring mobility, as well as educating patients on managing their condition to maintain long-term benefits. Occupational therapy also deals with rehabilitation and motion but is focused more on enabling the person to engage in daily activities as seamlessly as possible. Occupational therapists also suggest adaptations and modifications to the persons environment.3
There are several techniques that can help people with PD overcome freezing, including:
As with any symptom, patients who experience freezing episodes should mention this to their neurologist who is managing their care. The neurologist may make changes to medication or provide a referral to a physical or occupational therapist.
Why Does Freezing Of Gait Occur
It is not completely clear why some people with PD experience freezing of gait and others do not. Research suggests that there is a relationship between freezing of gait and cognitive difficulties. The brain circuitry that controls gait is extremely complex and involves multiple connections between various parts of the brain, including:
- areas in the front of the brain that plan and initiate movement
- areas of the basal ganglia where the dopaminergic neurons that refine and control movement are found
- areas in the brainstem which modulate movement and wakefulness
Freezing of gait seems to be caused by short-lasting episodes of inhibition of these brain circuits that coordinate gait. The specific abnormalities that cause the problem may differ from person to person.
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What Can You Do About Freezing
Many people have established their own ways of managing this symptom, as highlighted by one Parkinsons UK forum user:
My hubby walks backwards whilst holding my hands, I walk forwards and. now this is the best bit. I call one leg Tina and the other leg Turner. Off we go saying, Tina, Turner and repeat this until we reach our destination! We are usually in hysterics by the time we get to what ever room we are going to. But it does work!
Counting, chanting or singing in this way can help people to take that first step these are known as temporal cues as they tell people when to move. Imagining something to step over, or placing tape on the ground where freezing usually happens, can also help people to get moving again. These are spatial cues that inform people where to step.
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Parkinsons: Freezing Of Gait How To Manage It
For Parkinsons disease, freezing is a common symptom, but it can affect people in different ways.
In freezing episodes, a person freezes while walking, often when they are changing direction or about to take a step, as if their foot were glued to the ground. But freezing can also have repercussions on other movements. Some Parkinsons sufferers say they have had freezing episodes in the midst of continuous action, such as brushing their teeth or combing their hair.
Freezing can also affect speech and many people with Parkinsons say they often freeze midsentence. Most of the time, freezing in Parkinsons is a temporary action, which, although frustrating, is quickly overcome.
There are a few things you can do to prevent freezing episodes and to overcome them quickly when they occur.
Parkinsons Freezing Of Gait Results From A Disconnect Between The Brain And The Body
Freezing of gait is the inability to take the next step due to a damaged neural pathway that carries out brain-to-body communication. Those living with Parkinson’s describe feeling as if their feet are glued to the floor or planted in boxes of concrete. Freezing can manifest as trembling, shuffling of feet, or a complete inability to move and drastically increases the likelihood of a fall or injury among people with Parkinson’s.
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How Is Research Helping
Researchers are interested in optimising these cueing tactics to help people start moving again after freezing.
Cathy Craig is a researcher at Queens University Belfast whose work focuses on how the brain controls movement. Cathys research at the movement innovation lab makes use of a range of technologies, such as sensors and virtual reality, to study movement.
Previous research at the lab found audio cues useful for people with Parkinsons who freeze. The sound of footsteps in gravel worked particularly well. As footsteps are relevant to the action of walking and provide a continuous audio cue participants were able to keep their attention focused on the task at foot.
Freezing is difficult to provoke in a clinical setting which can make it hard for researchers to study. Cathy was interested in testing if virtual reality could be used to induce freezing.
Using virtual reality, you can create very realistic environments. We used virtual doorways to induce freezing in people with Parkinsons. Being able to induce freezing allows us to study it in a more systematic way.
Cathy was also interested in testing if visual cues in a virtual reality environment could be used to overcome freezing.
We tested a visual cue in a virtual reality environment a series of black footprints on the floor that light up at different times to give the impression of following someone similar to walking in someones footprints in snow.